Bronchiolitis: Not to be treated lightly

 Dr Wrishi Thakur Raphael

Brochiolitis is a disease which is clinically very similar to pneumonia. It is a viral condition (Respiratory Syncytial Virus being the most common organism) which affects children under 2 with peak age of 3 to 6 months. Specific mortality rates are yet to be obtained in our country, simply because of the unnecessary ssuse of antibiotics for all pneumonia like conditions (thus making it exceedingly difficult to identify and label bronchiolitis as a separate cause of infant mortality) and also of the lack of initiative of the health sector to project bronchiolitis as a disease which is pretty common and can have fatal outcomes on child health.

 

Bronchiolitis is commonly associated with:

Being around cigarette smoke

Being younger than 6 months old

Living in crowded conditions

Not being breastfed

Common symptoms associated with Bronchiolitis:

Bluish skin due to lack of oxygen (cyanosis) - emergency treatment is needed

Breathing difficulty including wheezing and shortness of breath

Cough

Fatigue

Fever

Muscles around the ribs sink in as the child tries to breathe in (called intercostal retractions)

Infant's nostrils get wide when breathing

Rapid breathing (tachypnea)

Complications

Cyanosis, a condition in which the skin appears blue or ashen, especially the lips, caused by lack of oxygen.

In the youngest infants, acute bronchiolitis can sometimes cause long pauses in breathing (apnea).

Dehydration.

Fatigue and respiratory failure.

Tests:

Chest X-ray. To look for signs of pneumonia.

Mucus sample test. Your doctor may collect a sample of mucus from your child to test for the virus causing bronchiolitis. This is done using a swab or a suction catheter that's gently inserted into the nose.

Blood tests; full blood count and blood gas analysis. Occasionally, blood tests might be used to check the child's white blood cell count. An increase in white blood cells is usually a sign that your body is fighting an infection. The blood gas analysis helps to determine child’s acid base balance in severe illnesses but it’s not required routinely. A blood test can also determine whether the level of oxygen has decreased in your child's bloodstream. An alternative test for oxygen levels is an oximeter that fits over the finger. Oxygen is necessary to the functioning of the body's organs, including the brain.

Treatment

In most cases bronchiolitis is mild and gets better without any specific treatment within about two weeks.

A small number of children will still have some symptoms after four weeks, and in a few cases the condition is severe enough to require treatment in hospital.

Treatment at home

If you're looking after your child at home, check on them regularly, including throughout the night. If their condition worsens, contact your GP.

Read more about the symptoms of bronchi

There is no medicine that can kill the viruses that cause bronchiolitis.

The following advice may help your child feel more comfortable while they recover.

Keep your child upright

This may help make their breathing easier and may be useful when they are trying to feed. If your child has a nap in an upright position, make sure that their head does not fall forward by supporting it with something, such as a rolled-up blanket.

Drink plenty of fluids

If your child is being breastfed or bottle fed, try giving them smaller feeds more frequently. Some additional water or fruit juice may help avoid dehydration.

Keep the air moist

If you have access to an air humidifier, using it to moisten the air may help to ease your child's cough.

Your home should be heated to a comfortable temperature, but do not make it too warm as this will dry out the air.

Keep a smoke-free environment

Inhaling smoke from cigarettes or other tobacco products may aggravate your child's symptoms. If you smoke, avoid doing so around your child.

Passive smoking can affect the lining of your child's airways, making them less resistant to infection. Keeping smoke away from your child may also help prevent future episodes of bronchiolitis.

Relieving a fever

If the child has a high temperature (fever) that is upsetting them, you can consider using paracetamol or ibuprofen, depending on their age. These are available over the counter from pharmacies without prescription.

Babies and children can be given paracetamol to treat fever or pain if they are over the age of two months. Ibuprofen may be given to children who are three months old or over and weigh at least 5kg (11lbs).

Saline nasal drops

Saline (salt water) nasal drops are easily available and cheap. Placing a couple of drops of saline inside your child's nose before they feed may help to relieve a blocked nose.

Treatment in hospital

Some children with bronchiolitis need to be admitted to hospital. This is usually necessary if they aren't getting enough oxygen into their blood because they are having difficulty breathing, or if they aren't eating or drinking enough.

Extra oxygen

The level of oxygen in your child's blood will be measured with a pulse oximeter. This is a small clip or peg that is attached to your baby's finger or toe.

Feeding

If your child is having trouble feeding, they may be given fluids or milk through a feeding tube. This is a thin plastic tube that goes into your child's mouth or nose and down into their stomach. Alternatively, they may be given fluids intravenously

Nasal suction

If your child's nose is blocked and they have trouble breathing, nasal suction may be used. This involves a small plastic tube being inserted into their nostrils to clear out the mucus.

To future clinicians and paeditricians around the country, please do not prescribe antibiotics to bronchiolitis patients since all evidence of antibiotic therapy is proving ineffective. Injudicious use of antibiotics will only increase the impact of multi drug resistant strains of micro-organisms; a burden which already weighs heavy on our health system.  (Reprint)

 

Bronchiolitis: Not to be treated lightly

Dr Wrishi Thakur Raphael Brochiolitis is a disease which is clinically very similar to pneumonia. It is a viral condition (Respiratory Syncytial Virus being the most common organism) which affects children under 2 with peak age of 3 to 6 months. Specific mortality rates are yet to be obtained in our country, simply because of the unnecessary ssuse of antibiotics for all pneumonia like conditions (thus making it exceedingly difficult to identify and label bronchiolitis as a separate cause of infant mortality) and also of the lack of initiative of the health sector to project bronchiolitis as a disease which is pretty common and can have fatal outcomes on child health. Bronchiolitis is commonly associated with: Being around cigarette smoke Being younger than 6 months old Living in crowded conditions Not being breastfed Common symptoms associated with Bronchiolitis: Bluish skin due to lack of oxygen (cyanosis) - emergency treatment is needed Breathing difficulty including wheezing and shortness of breath Cough Fatigue Fever Muscles around the ribs sink in as the child tries to breathe in (called intercostal retractions) Infants nostrils get wide when breathing Rapid breathing (tachypnea) Complications Cyanosis, a condition in which the skin appears blue or ashen, especially the lips, caused by lack of oxygen. In the youngest infants, acute bronchiolitis can sometimes cause long pauses in breathing (apnea). Dehydration. Fatigue and respiratory failure. Tests: Chest X-ray. To look for signs of pneumonia. Mucus sample test. Your doctor may collect a sample of mucus from your child to test for the virus causing bronchiolitis. This is done using a swab or a suction catheter thats gently inserted into the nose. Blood tests; full blood count and blood gas analysis. Occasionally, blood tests might be used to check the childs white blood cell count. An increase in white blood cells is usually a sign that your body is fighting an infection. The blood gas analysis helps to determine childs acid base balance in severe illnesses but its not required routinely. A blood test can also determine whether the level of oxygen has decreased in your childs bloodstream. An alternative test for oxygen levels is an oximeter that fits over the finger. Oxygen is necessary to the functioning of the bodys organs, including the brain. Treatment In most cases bronchiolitis is mild and gets better without any specific treatment within about two weeks. A small number of children will still have some symptoms after four weeks, and in a few cases the condition is severe enough to require treatment in hospital. Treatment at home If youre looking after your child at home, check on them regularly, including throughout the night. If their condition worsens, contact your GP. Read more about the symptoms of bronchi There is no medicine that can kill the viruses that cause bronchiolitis. The following advice may help your child feel more comfortable while they recover. Keep your child upright This may help make their breathing easier and may be useful when they are trying to feed. If your child has a nap in an upright position, make sure that their head does not fall forward by supporting it with something, such as a rolled-up blanket. Drink plenty of fluids If your child is being breastfed or bottle fed, try giving them smaller feeds more frequently. Some additional water or fruit juice may help avoid dehydration. Keep the air moist If you have access to an air humidifier, using it to moisten the air may help to ease your childs cough. Your home should be heated to a comfortable temperature, but do not make it too warm as this will dry out the air. Keep a smoke-free environment Inhaling smoke from cigarettes or other tobacco products may aggravate your childs symptoms. If you smoke, avoid doing so around your child. Passive smoking can affect the lining of your childs airways, making them less resistant to infection. Keeping smoke away from your child may also help prevent future episodes of bronchiolitis. Relieving a fever If the child has a high temperature (fever) that is upsetting them, you can consider using paracetamol or ibuprofen, depending on their age. These are available over the counter from pharmacies without prescription. Babies and children can be given paracetamol to treat fever or pain if they are over the age of two months. Ibuprofen may be given to children who are three months old or over and weigh at least 5kg (11lbs). Saline nasal drops Saline (salt water) nasal drops are easily available and cheap. Placing a couple of drops of saline inside your childs nose before they feed may help to relieve a blocked nose. Treatment in hospital Some children with bronchiolitis need to be admitted to hospital. This is usually necessary if they arent getting enough oxygen into their blood because they are having difficulty breathing, or if they arent eating or drinking enough. Extra oxygen The level of oxygen in your childs blood will be measured with a pulse oximeter. This is a small clip or peg that is attached to your babys finger or toe. Feeding If your child is having trouble feeding, they may be given fluids or milk through a feeding tube. This is a thin plastic tube that goes into your childs mouth or nose and down into their stomach. Alternatively, they may be given fluids intravenously Nasal suction If your childs nose is blocked and they have trouble breathing, nasal suction may be used. This involves a small plastic tube being inserted into their nostrils to clear out the mucus. To future clinicians and paeditricians around the country, please do not prescribe antibiotics to bronchiolitis patients since all evidence of antibiotic therapy is proving ineffective. Injudicious use of antibiotics will only increase the impact of multi drug resistant strains of micro-organisms; a burden which already weighs heavy on our health system. (Reprint)